Healthcare Provider Details

I. General information

NPI: 1497212021
Provider Name (Legal Business Name): JARED LOUW CRNA, DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

PO BOX 980541
RICHMOND VA
23298-0541
US

V. Phone/Fax

Practice location:
  • Phone: 508-904-8228
  • Fax:
Mailing address:
  • Phone: 804-628-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024180140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: